Cardiology Service: Recheck Visit Questionnaire

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What clinical signs are you observing? (ex: coughing/ gagging, wheezing or other changes in breathing, fainting, fatigue or exercise intolerance, etc.)

If yes, would your like written prescriptions or pills to take home today?

Yes

No

What tests has your veterinarian done since these signs have manifested? (ex: xrays, bloodwork, or EKG)

Is your pet eating and drinking normally? Are urinations and bowel movements normal?

Please list all medications your pet is taking, including the strength, dose, how often they take it, and the time it was last administered (ex: furosemide 12.5mg – 1 tablet two times per day, last given at 8AM today)

Do you feel there has been a change in your pet’s symptoms since your last visit?